[Pharmwaste] RE: reasons to continue despite low % of water
contamination
Ed Gottlieb
egottlieb at cityofithaca.org
Mon Dec 27 07:09:13 EST 2010
However small the percentage of water contamination that is caused by flushed (or leached) medications, I would like to add additional reasons to continue promoting take backs. Simply look at the statistics of dramatically increasing teen and adult prescription drug abuse or the rapidly climbing and astronomically high cost of treating overdoses in this country. A take back program removes medications from possible diversion by teens and others. It also cuts the chances of an adult mistakenly taking the wrong medication or a child getting into them. If a take back keeps one teen from getting started on the path of drug abuse or prevents a single accidental overdose, it has certainly paid for itself and been worth all the effort.
Ed Gottlieb
Industrial Pretreatment Coordinator
Ithaca Area Wastewater Treatment Facility
525 3rd Street
Ithaca, NY 14850
(607) 273-8381
fax: (607) 273-8433
egottlieb at cityofithaca.org
>>> "Tenace, Laurie" <Laurie.Tenace at dep.state.fl.us> 12/22/2010 4:02 PM >>>
Thanks for forwarding that link, Burke.
I have not yet read Dr. Daughton's recent report but wanted to comment.
One reason to continue promoting take backs, even lacking evidence of flushing being a major contributor, is that the public does not want to feel helpless about their personal contribution to drugs in the environment. The alleviation of that helplessness is not measurable but still important and if you are like me, taking phone calls from concerned citizens every day, you will understand the importance of having something to offer the public.
Happy Holidays and Merry Christmas to all my friends around the country. Thank you for making this list serve such a great tool.
Laurie
The Department of Environmental Protection values your feedback as a customer. DEP Secretary Mimi Drew is committed to continuously assessing and improving the level and quality of services provided to you. Please take a few minutes to comment on the quality of service you received. Simply click on this link to the DEP Customer Survey<http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us>. Thank you in advance for completing the survey.
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Lucy, Burke
Sent: Tuesday, December 21, 2010 8:30 PM
To: 'Gilliam, Allen'; Pharmwaste Listserve (pharmwaste at lists.dep.state.fl.us)
Cc: Price, John L. "Jack"; 'Jeff Hollar'; 'hessenauer.meghan at epa.gov'; 'swietlik.william at epa.gov'
Subject: [Pharmwaste] RE: low metabolic rate for antibiotics
Here's a good excerpt from Dr. Christian Daughton's Sept. 2010 report, "Drugs and the Environment: Stewardship & Sustainability," (available: http://www.epa.gov/nerlesd1/bios/daughton/APM200-2010.pdf) that touches on this issue:
Disposal's contributions may very well prove significant for a select few medications. But for many or most others, it will undoubtedly prove minuscule. Many figures on the contributions from disposal have been recited in the non-peer-reviewed literature and at conferences but they lack any supporting data. Most are based on conjectures or guesstimates.
The use of collection programs for leftover drugs to reduce the occurrence of APIs in waterways does not yet have a science-based justification. To date, no study has performed an assessment of the effectiveness of take-back programs in reducing API levels in sewage or the environment.
The need for data showing the relative contributory role played by disposal in the occurrence of APIs in the environment was identified as a research gap in EPA-ORD publications as early as 2004 (Daughton 2004; 2007). There are few other publications (e.g., Houskeeper 2009) that highlight this unknown, and fewer yet that point out the lack of this evidence for justifying the need for take backs. This means that much of the ongoing effort in developing drug collection programs based on protection of the environment lacks a body of supporting data for justification.
Representing the view that disposal to sewers is a comparatively unimportant source is the perspective of PhRMA. Those involved with PhRMA's workgroup on pharmaceuticals in the environment (PiE) (Anon 2010; Finan and Wood 2008; Finan et al. 2007) maintained that the contributions of APIs to sewers via drug disposal are practically insignificant: "Even with current disposal practices, drain disposal of unused medicines is very unlikely to contribute more than 10% of the APIs found in WWTP influents." "It is likely that there would be little effect (less than a 1 part per trillion) on WWTP API influent concentrations as a result of implementing unused medicine take back programs compared to household trash disposal." "Either household trash disposal or take back programs can reduce the unused medicine contribution of APIs in WWTP influent to < 1%".
>From a different perspective, perhaps the first (and only) attempt at quantitative modeling based on actual data for APIs disposed to sewers was published in 2007 (Ruhoy and Daughton 2007). Calculations done for the disposal of carbamazepine by a county coroner's office estimated a concentration in raw sewage influent of 1.4 ppt (1 ng/L). This is significant, as it represented the disposal practices from but one small sector of society. The most in-depth examination of the possible role of disposal in contributing to ambient environmental residues was presented by Daughton and Ruhoy (2009a); among the many findings was that disposal could possibly serve as a major source of certain select APIs in the environment - primarily those that are extensively metabolized (poorly excreted).
I think we can agree the majority of drug waste is excreted. The question is where that majority falls: closer to 51% or 99%. We continue to learn how chemicals in our environment are affecting us. For instance, the chemicals you're exposed to affect your grandchildren's health (aka, transgenerational epigenetic inheritance: http://www.newsweek.com/2010/10/30/how-your-experiences-change-your-sperm-and-eggs.html). In the absence of scientific data showing how big a problem the pseudo persistence of unused pharmaceutical waste is, the primary question I have to continually ask is when should the political approach consider the precautionary principle?
Mr. Burke Lucy
Integrated Waste Management Specialist
Department of Resources Recycling and Recovery (CalRecycle)
1001 I Street, PO Box 4025
Sacramento, CA 95812
Burke.Lucy at CalRecycle.ca.gov
916.341.6592 (recently changed)
From: Gilliam, Allen [mailto:GILLIAM at adeq.state.ar.us]
Sent: Tuesday, December 21, 2010 7:30 AM
To: Pharmwaste Listserve (pharmwaste at lists.dep.state.fl.us)
Cc: 'john.l.price at dep.state.fl.us'; Lucy, Burke; 'Jeff Hollar'; 'hessenauer.meghan at epa.gov'; 'swietlik.william at epa.gov'
Subject: low metabolic rate for antibiotics
Pharma experts and "wanna bees",
(See table and related e-mails waaaay below for main info and resources....)
I'm cleaning out the e-mailbox and ran across this one (which all of you should have already seen). Just thought I'd throw it "out there" once again for any updates, comments or clarifications. Sources of the info are footnoted at the bottom by Mr. Burke Lucy and others. Similar questions as mine are voiced by Mr. Jack Price. Looks like Ms. Dayton started all this back in 2/10.
To me, the (obviously non-exhaustive) table indicates antibiotics readily pass thru the human body without being metabolized, straight into the sewer helping the super bugz continue to their quest to overtake cockroaches on the planet.
Doxycycline, Erythromycin, Lincomycin, Oxytetracyline and Tetracycline - 0% metabolized by human beans (and livestock?)? And, others show really low metabolic rates.
I believe Dr. Volkman passionately responded to my last inquiry about, "why these (and probably dozens of other antibiotics) are even prescribed anymore?" Does this "0% loss by human metabolism" mean they should be completely taken off the market?
Any pharmaceutical company reps "out there" willing to comment? Any veterinarians "out there" want to comment why cattle are receiving antibiotics for no reason? (and yes, Dave, I often run behind my herd with a sooper pooper scooper to flush rather than let a rain event wash the Oklahoma frizbees into the local watersheds!)
Any updates from the pharma lobbyists since this was originally sent?
Does anyone know if ANYTHING is being done about this waste?
happy holidaze to y'all!
slowly metabolizing myself,
allen gilliam
adeq state pretreatment type guy
501.682.0625
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Lucy, Burke
Sent: Wednesday, February 10, 2010 12:26 PM
To: 'Price, John L. "Jack"'
Cc: Pharmwaste Listserve (pharmwaste at lists.dep.state.fl.us)
Subject: RE: [Pharmwaste] 75-82% by excretion - question on the data table percentages
Jack,
I had the same question - good to know it wasn't just me. I suspect others on this list could provide a more authoritative answer than I. The numbers were taking from slide #11 in the referenced presentation. I only included the numbers that could be compared with other findings. Here is the whole table as presented:
Estimated API Concentrations From Patient Use
(also influent concentration if all unused medicine is taken back for incineration)
[cid:image001.png at 01CBA1B0.DFD20470]
These numbers were drawn from a non-peer reviewed report. At least we have some peer review on this listserv.
Burke
From: Price, John L. "Jack" [mailto:John.L.Price at dep.state.fl.us]
Sent: Wednesday, February 10, 2010 6:29 AM
To: Lucy, Burke
Cc: Pharmwaste Listserve (pharmwaste at lists.dep.state.fl.us)
Subject: FW: [Pharmwaste] 75-82% by excretion - question on the data table percentages
Burke: Thanks for this handy compilation of the variability of the metabolism among drugs and among research conclusions. I do have a question.
Looking at the data columns title "% Loss by Metabolism," it appears that the percentages in this table are the percentage of a medication that is absorbed or otherwise metabolized by the body rather than the percentage that is excreted unmetabolized. It puzzles me, then, that erythromycin and metformin, according to the PhRMA study, are not metabolized at all. Further, only 10 or 11%, respectively, of acetaminophen and ciprofloxacin are absorbed or otherwise metabolized. Am I reading this table correctly? Or is it the case that the percentages in this data table are the percentages that are excreted unmetabolized, i.e., not absorbed or otherwise metabolized by the body?
What am I missing? Your assistance, please.
John L. (Jack) Price
Environmental Manager
Waste Reduction MS 4555
Florida Department of Environmental Protection
2600 Blair Stone Road
Tallahassee, FL 32399-2400
Phone:850.245.8751
Fax: 850.245.8811
john.l.price at dep.state.fl.us<mailto:john.l.price at dep.state.fl.us>
www.dep.state.fl.us/waste<http://www.dep.state.fl.us/waste>
From: Lucy, Burke [mailto:Burke.Lucy at CalRecycle.ca.gov]
Sent: Thursday, February 04, 2010 5:12 PM
To: 'Gressitt, Stevan'; Barry Fernandez; Galvin, Dave; Jeff Hollar; Sue Dayton; Tenace, Laurie; Howard Anderson; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] 75-82% by excretion
Here's an example of some of the variability in metabolism rates reported from various sources:
% Loss by Metabolism
Drug
PhRMA1
Other
Ibuprofen
78%
90%2
Erythromycin
0%
75%2
Sulfamethoxazole
88%
85%2
Acetaminophen
10%
> 80%3
Fluoxetine
90%
> 80%3
Ciprofloxacin
11%
50%3
Digoxin
16%
50%3
Metformin
0%
< 20%3
1 An Evaluation of Unused Medication Disposal Options, Available: http://www.mainebenzo.org/MaineUnusedDisposalConferencePresentationFinal.pptx
2 Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom, Available: http://ehp.niehs.nih.gov/members/2005/8315/8315.pdf
3 Pharmawater-Metabolism, Available: http://hosted.ap.org/specials/interactives/pharmawater_site/day1_08.html
Mr. Burke Lucy
Integrated Waste Management Specialist
Department of Resources Recycling and Recovery (CalRecycle)
(formerly California Integrated Waste Management Board)
1001 I Street, PO Box 4025
Sacramento, CA 95812
Burke.Lucy at CalRecycle.ca.gov
916.324.6848
From: Gressitt, Stevan [mailto:Stevan.Gressitt at maine.gov]
Sent: Thursday, February 04, 2010 2:07 PM
To: Lucy, Burke; Barry Fernandez; Galvin, Dave; Jeff Hollar; Sue Dayton; Tenace, Laurie; Howard Anderson; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] 75-82% by excretion
Some thoughts from others on the variability of metabolism....
http://www.fda.gov/OHRMS/DOCKETS/AC/03/slides/3944s1_10-lesko.ppt#275,36,Modern Rendition of Paracelsus
http://content.nejm.org/cgi/content/full/348/6/538
and see warfarin variability: http://www.medscape.com/viewarticle/588997_6
and there are more complexities than just age, or sex:
http://www.nature.com/tpj/journal/v4/n4/full/6500251a.html
Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME 04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov<mailto:stevan.gressitt at maine.gov>
http://www.maine.gov/dhhs/mh/
________________________________
From: Lucy, Burke [mailto:Burke.Lucy at CalRecycle.ca.gov]
Sent: Thursday, February 04, 2010 4:53 PM
To: 'Barry Fernandez'; Galvin, Dave; Gressitt, Stevan; Jeff Hollar; Sue Dayton; Tenace, Laurie; Howard Anderson; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] 75-82% by excretion
I'm spending as much time as I can to review the peer-reviewed journal articles for my report on pharmaceutical collection due to the California legislature in December. So far, the best I've found to address the % metabolized question is this:
Bound J. P., Voulvoulis N. 2005. Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom (Environmental Health Perspectives). Available: http://ehp.niehs.nih.gov/members/2005/8315/8315.pdf.
They list the percent that several drugs metabolize/are excreted from people. For instance, 15% of the parent compound of Sulfamethoxazole (antibiotic) is excreted. But then I understand even that is a complicated conclusion.
Nontherapeutic use of antibiotics in cattle, swine, and poultry represents 70% of all drug use (87% if you count total nonhuman uses) according to:
Mellon M, Benbrook C, and Benbrook KL. 2001. Hogging It! Estimates of Antimicrobial Abuse in Livestock (Cambridge, MA: Union of Concerned Scientists). Available: http://www.ucsusa.org/food_and_agriculture/science_and_impacts/impacts_industrial_agriculture/hogging-it-estimates-of.html.
According to this non-peer reviewed article, at least 50% of the antibiotic ciprofloxacin is used:
http://hosted.ap.org/specials/interactives/pharmawater_site/day1_08.html
According to this non-peer reviewed PhRMA PowerPoint, 11% of the antibiotic ciprofloxacin is used:
http://www.mainebenzo.org/MaineUnusedDisposalConferencePresentationFinal.pptx (change the .zip extension back to .pptx to fix the download glitch)
So, if 70% of all drug use represents antibiotics in cattle, swine, and poultry and if these wide-ranging human antibiotic results are any measure, bottom line, animal "pass-through" represents...a lot.
I think the last non-peer reviewed PhRMA reference is where many people get the "over 99% of these drugs come from excretions" number. But to start with, that assumes 10% of all drugs go unused and I think that may be higher. If anyone knows of any more good references along these lines, please let me know.
Mr. Burke Lucy
Integrated Waste Management Specialist
Department of Resources Recycling and Recovery (CalRecycle)
(formerly California Integrated Waste Management Board)
1001 I Street, PO Box 4025
Sacramento, CA 95812
Burke.Lucy at CalRecycle.ca.gov
916.324.6848
________________________________
From: Galvin, Dave [mailto:Dave.Galvin at kingcounty.gov]
Sent: Thursday, February 04, 2010 12:38 PM
To: Gressitt, Stevan; Jeff Hollar; Sue Dayton; Tenace, Laurie; Howard Anderson; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] 75-82% by excretion
I agree with Dr. G. While it is interesting to see a quote in a local newspaper that says, "Studies show...," it would be a whole lot more interesting to see the actual studies! This is an area that has been rife with speculation and estimates, but essentially nonexistent in terms of documented studies. Let's hope some good ones are underway, or that someone on this listserv can provide links to peer-reviewed publications. Thanks, all. -- Dave Galvin
Dave Galvin o King County Department of Natural Resources and Parks o 130 Nickerson Street, Seattle, WA 98109-1658 o (w) 206-263-3085 o (fax) 206-263-3070 o dave.galvin at kingcounty.gov<mailto:dave.galvin at kingcounty.gov> o Local Hazardous Waste Management Program in King County o www.govlink.org/hazwaste/<http://www.govlink.org/hazwaste/>
________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Gressitt, Stevan
Sent: Thursday, February 04, 2010 9:31 AM
To: Jeff Hollar; Sue Dayton; Tenace, Laurie; Howard Anderson; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] 75-82% by excretion
Thanks for this, I think we are still looking for the actual studies though.
Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME 04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov<mailto:stevan.gressitt at maine.gov>
http://www.maine.gov/dhhs/mh/
________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Jeff Hollar
Sent: Thursday, February 04, 2010 12:08 PM
To: 'Sue Dayton'; 'Tenace, Laurie'; 'Howard Anderson'; pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] 75-82% by excretion
Here's a recent article by Richard Hanners that indicates: "Studies show that 75 to 82 percent of the drugs found in wastewater treatment plants are attributable to human and animal "pass-through," rather than direct drug disposal as waste."
The full story is available at: http://www.flatheadnewsgroup.com/articles/2010/02/04/whitefishpilot/news/news_8734779997_01.txt
I would suggest the remaining 18-25% is something that we do have the technology and resources to properly manage. It's the right thing and in some cases the legal thing to do.
Jeff Hollar
President
PharmWaste Technologies, Inc.
4164 NW Urbandale Dr., Suite A
Urbandale, IA 50322
(P) 515-276-5302 Ext. 316
(F) 480-393-5564
(E) Jhollar at Pwaste.com<mailto:Jhollar at Pwaste.com>
(W) www.pwaste.com
From: Sue Dayton [mailto:sdayton at swcp.com]
Sent: Thursday, February 04, 2010 9:59 AM
To: 'Tenace, Laurie'; 'Howard Anderson'; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: Chemicals in water altering genders offish(*LakePepin, Peedee and Potomac Rivers)
Yes, please! I have read somewhere that it is not that high....
Sue Dayton
Blue Ridge Environmental Defense League
North Carolina Healthy Communities Program
PO BOX 44
Saxapahaw, NC 27340
(336) 525-2003
sdayton at swcp.com<mailto:sdayton at swcp.com>
________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Tenace, Laurie
Sent: Thursday, February 04, 2010 8:33 AM
To: 'Howard Anderson'; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: Chemicals in water altering genders offish(*LakePepin, Peedee and Potomac Rivers)
Howard,
Can you share your reference showing that 99% is excreted?
Thanks,
Laurie
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Howard Anderson
Sent: Wednesday, February 03, 2010 5:55 PM
To: 'Sue Dayton'; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: Chemicals in water altering genders of fish (*LakePepin, Peedee and Potomac Rivers)
Dear Pharmwaste List:
Remember that over 99% of these drugs come from excretions by those of us who take the drugs and excrete metabolites, or in many cases largely unchanged drug. We should concentrate our efforts on teaching our sewage systems to render the chemicals benign. Sometimes we spend a lot of time and money trying to solve 1 percent of the problem, when we should be better served solving the 99 percent. Then the extra 1 percent would come along, as a matter of course.
Sincerely,
Howard
Howard C. Anderson, Jr.,R.Ph.
Executive Director
North Dakota Board of Pharmacy
1906 E. Broadway Ave.
P.O. Box 1354
Bismarck, ND 58502-1354
Phone (701) 328-9535
Fax (701) 328-9536
Web site www.nodakpharmacy.com
________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Sue Dayton
Sent: Wednesday, February 03, 2010 1:22 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] FW: Chemicals in water altering genders of fish (*LakePepin, Peedee and Potomac Rivers)
The "generating source" for these hormone-disrupting chemicals found in rivers and streams is PEOPLE as part of the never-ending waste stream from homes, businesses, restaurants, hospitals, research labs, veterinary clinics, funeral homes, nursing homes, and industry which takes a brief stop at the local wastewater treatment plant before these unregulated and untested and unremoved hormone disrupting chemicals are discharged as effluent into surface waters and onto farmlands via sewage sludge (aka, biosolids) where the chemicals are found to concentrate. The problem may not just be affecting smallmouth bass, carp, catfish and sturgeon, but humans as well seen through research studies showing decreasing sperm counts in men. A video is also available for viewing at this link. Thoughts, anyone? -- Sue
.........................................................
More information about the Pharmwaste
mailing list